Have you checked out the ACS Medical Legal Page?
The ACS Medical Legal page is loaded with information that will help your personal injury practice. It's foundation is Dr. Immerman's work as an expert in the personal injury field. He has testified in 60 Superior Court trials in the past 10 years and written hundreds of reports. Take a look at the posted information.
ACS members constantly contact Dr. Immerman for copies of studies to back up their arguments in reports, and to prepare for court. Just go
and click on the Medical Legal page button. Members can contact Dr. Immerman for the most up-to-date information and studies available, and for personal assistance on specific cases.
August 2010 ACS Newsletter:
Read entire PDF with breaking news about the Board, insurance equality and much more by clicking on this link.
|The Arizona Chiropractic Society is here to serve you!|
3515 E. Carol Avenue
Phoenix, AZ 85028
|Dear Arizona Chiropractor and other interested party,|
This is a special mid-month update from ACS. Please forward this to any of your fellow Arizona chiropractors or anyone else who would benefit from the information here. Also, please feel free to contact us with any questions or, if you wish to no longer receive these important communications, click the unsubscribe link at the bottom.
Alan M. Immerman, D.C.
President & Executive Director
THE ONLY SOLUTION FOR BCBS' HIRING OF ASH IS THE ACS COPAY LAWSUIT AGAINST THE ARIZONA DEPARTMENT OF INSURANCE
The Arizona insurance equality law, ARS 20-461 A.17 and B, requires that BCBS cover all chiropractic care that is "reasonable and necessary." If ASH routinely limits care to 6-8 visits in the BCBS PPO plans which is widely considered under-treatment, ACS will make this an issue in the same lawsuit that is being filed against the Arizona Department of Insurance (ADOI) to end higher copays and deductibles for chiropractic care.
ACS is pleased to announce that we are 50% of the way towards meeting our fundraising goals for the lawsuit after only one month of trying. This indicates the commitment of the profession to ending discriminatory copays and deductibles with the ACS litigation. It will be easy to finish funding the lawsuit over the next few months.
A lawsuit cannot be filed directly against any insurance company for violating the insurance equality law because this law is part of the Unfair Claims Settlement Practices Act. This Act can only be enforced by ADOI. Therefore, lawsuits can only be filed against ADOI for failing to properly enforce the law. That is what ACS is planning to do this fall.
A lawsuit against ADOI truly is the only solution. More legislation would only duplicate existing protections. ACS learned this directly from ADOI in writing in 2008. The problem is refusal of ADOI to enforce existing law, not absence of sufficient good law. ACS has had insurance lawyers analyze all issues to affirm these facts.
ACS was hopeful for support from the AAC but those hopes were dashed with the following recent statement in an AAC publication from Don Dearth, DC, chairman of the AAC Insurance Committee: "Although some may want to rush to legal action, at this point this AG letter helps define the arguments we can use to make changes legislatively. With difficult financial situations for many to pay for legal action, a continued division in our profession . . ."
ACS could not disagree more. As chiropractors struggle to survive, no one is "rushing" to legal action. Now is the right time for this lawsuit. ACS has been carefully studying and planning this action for two years. This is absolutely the wrong time to return to the legislature for solutions. That route has already been tried and exhausted in 2007 and 2008. Furthermore, even though Dr. Dearth's perception is that a lawsuit cannot be funded now due to current "difficult financial situations," ACS has already raised more than half the funds necessary in only one month of trying.
ACS' effort is not suffering due to current financial conditions or the alleged "continued division in our profession." ACS sees a profession that is coming together like never before to support this seminal lawsuit to enforce our insurance equality law. We see unity. We also see no reluctance from doctors to contribute to this effort. We will fully fund and file this lawsuit, and we will fight to the end to win. A false perception that the profession is divided and has no financial resources may in fact simply reflect a failure in leadership.
We urge you again to read the letter written by ACS insurance lawyer Frederick Berry, Jr. to the AG at http://www.azchiropractors.org/documents/BerrylettertoAGMarch2009.pdf. This will help you understand why we believe we will win this lawsuit.
ACS requests that all doctors contribute $500. Please mail a check for $500 (or as much as you can afford) made out to ACS or authorize ACS to bill your credit card on file. Send to 3515 E. Carol Ave., Phoenix, AZ 85028. If you are not a member, please join by going to www.AZChiropractors.org. Once the war chest is funded, the lawsuit against ADOI will be filed and justice will be on its way. ACS is handling this litigation with no help from the AAC or any other organization.
Post Payment Audit Reviews and Refund Demands
ACS is working with a team of attorneys who have determined that most refund demands made by insurers months after claims have been paid are illegal. If the insurer is BCBS or AETNA, litigation is already ongoing and you may be able to join the lawsuit and stop a current refund demand immediately. With other insurers, ACS is working to develop new lawsuits.
ACS has created a Post Payment Audit Review and Refund Demand Package available to members. If you are a member and would like a copy of this highly informative package, send an email request. If you are not a member, join and we will send you a copy. The bottom line is you should NOT just automatically give in to refund demands without first consulting ACS. We may have legal remedies that will save you tens of thousands of dollars. Feel free to call ACS to discuss your situation. We are here for you!
ACS MEMBERSHIP BENEFITS AND DOCUMENTS
THE MOST POPULAR ACS MEMBER BENEFIT
Getting personal help from Dr. Immerman to collect from insurance companies and in personal injury cases is by far the most important and popular member benefit in ACS. Whether by email or phone, doctors frequently contact Dr. Immerman for help when health insurance companies refuse to pay claims and they have tried everything they know but have failed to collect. Dr. Immerman is known to usually have a solution when no one else does. A quick phone call or email often solves the problem.
Doctors also call when they are having trouble collecting on large PI cases. Sometimes an attorney refuses to release funds, or an attorney does not know how to approach a case. Dr. Immerman is frequently involved in litigation cases as an expert and knows many attorneys and so can often help in this area also.
There is a good reason why ACS' membership retention rate is one of the highest in the nation for a state association. It simply pays to be a member of ACS!
THE ARIZONA SUCCESSFUL PRACTICE PACKAGE IS READY FOR YOU
This is the full current list of membership benefits delivered to you immediately when you join ACS. If are you are licensed DC in Arizona and you really want to make a living at chiropractic, you will become a member of ACS and read and digest all of the documents listed below. Each is vital to practice in this state.
Members receive all of the following special membership benefits by email immediately upon joining. Any member may request an additional copy at any time by number. Join today and get the help you need with these unique resources and documents.
HEALTH INSURANCE FOR ACS MEMBERS WITH NO MEDICAL QUESTIONS ASKED
1 -- Health Insurance -- ACS Membership Form.pdf: Group health insurance for ACS members with guaranteed issue coverage after a 90 day waiting period, no medical underwriting. PPO and HMO plans, statewide.
2 -- Health Insurance Info.pdf
3 -- Health Insurance Pamphlet.PDF
HOW TO GET PAID WHEN AN INSURER DENIES OR REDUCES YOUR CLAIM
4 -- Fees allegedly above Usual and Customary.pdf: How to protest when an insurance company claims your fees were too high.
5 -- Grievance Letters -- The Best Way to Get Insurers to Pay.pdf: How to use the Arizona grievance law, a powerful tool to bring pressure on an insurer that misbehaves.
6 -- Health Care Appeal Request Form.pdf: There is a legal process when a claim is denied as not medically necessary. This is a sample request form. #7 contains complete instructions.
7 -- Health Care Appeals Process.pdf: A three level process. The third level involves review by an independent party chosen by the Arizona Department of Insurance and paid for by the insurance company.
8 -- How to file a complaint with ADOI against an insurer.pdf: When insurance companies violate laws, complaints must be filed.
9 -- Medical necessity appeal letter.pdf: An excellent general appeal letter.
10 -- Small Claims and Justice Court Instructions.PDF: Sometimes the only solution when an insurance company does not pay is a lawsuit. Here are instructions for suing an insurance company.
11 -- Timely Payment of Claims, Adjudication, Adjustments.pdf: Claims must be paid within a certain time frame, and demands for repayment can only be made within certain guidelines. This document contains the legal details.
HOW TO HANDLE AN ERISA SELF INSURED CLAIM DENIAL
12 -- ERISA Claims Procedure DOL Rule 29 CFR 2560.503-1.pdf: Key section of the law which you need to know to get results with your appeals.
13 -- ERISA Letter to File an Appeal.pdf: Use this letter today to get results when claims are denied.
14 -- ERISA Letter to Request for a Copy of the Summary Plan Description, Claim Appeal Procedure, EOB.pdf: The first step in an ERISA appeal is to get a copy of the plan document. This is the letter to send.
15 -- ERISA Self-Insured Plans ADOI Letter.pdf: This is the position of the Arizona Department of Insurance regarding ERISA self-insured plans.
16 -- Understanding ERISA.pdf: Complicated subject, simple explanation.
17 -- Understanding ERISA Detailed.pdf: Complicated subject, detailed but understandable explanation.
THE MOST EFFECTIVE PLAN TO DEVELOP REFERRALS FROM MDs
18 -- The path to medical referrals.pdf: Key information about how to get referrals from MDs and DOs.
19 -- MD-DC Alignment in Practice.pdf: An entire book by a DC who once was a drug representative and knows exactly how to get into and talk comfortably with MDs and DOs. This is a blueprint with detailed plans.
HOW TO STAY COMPLIANT IN ARIZONA WITH RECORD KEEPING AND DOCUMENTATION
20 -- Recordkeeping as Mandated by the Arizona Chiropractic Board.pdf: Detailed instruction complied and updated by ACS over many years.
21 -- Record Keeping and Documentation Course.pdf: Outline of course given by lead auditor retained by the Arizona Chiropractic Board.
22 -- Record Keeping 2005.pdf: Full course notes given by former Board chair. Must request separately since file too large to include with email package.
23 -- Medicare Chiropractic Coverage and Documentation Nov. 2006.pdf: This is the full document from Medicare and must be requested separately since it is too large.
24 -- CMS Rules for reporting timed codes.pdf: These are the rules for reporting timed codes which you must follow to be in compliance with the requirements of the Arizona Chiropractic Board for all documentation.
COMPLIANCE -- INFORMATION -- COLLECTIONS -- BOARD
25 -- Medical Records Protocol 2008.pdf: Arizona Chiropractic Board requires you have this on file in your office at all times.
26 -- How to search the National Library of Medicine and retrieve articles from a medical library.pdf: These are the types of journal articles the Arizona Chiropractic Board requires you to have to back up your claims.
27 -- DC Power of Attorney directing payments to doctor.pdf: Use when an insurance company refuses to honor assignments of benefits.
28 -- DC Power of Attorney Instructions.pdf: Instructions for #27.
29 -- State Board Investigations and Disciplinary Actions.pdf: Every doctor with a state license needs to read this background document about boards and discipline. Forewarned is forearmed.
PI TOOLS: LIENS, BALANCE BILLING, ETHICS . . .
30 -Ethics Opinion 98-06 which requires PI lawyers to pay your bill if they know it exists (constructive knowledge) even if there is no written agreement.
31 - Balance Billing in PI Cases: Why balance billing to a third party insurer is almost always allowed in PI cases including citations to legal authorities.
32 - PI Attorney's Explanation of Healthcare Provider Liens: Detailed explanation of the law.
33 - Sample form for Notice and Claim of Medical Lien: Fill in the blanks with your office information.
34 - Sample form for Release of Medical Lien: Fill in the blanks with your office information.
35 - Arizona Department of Insurance Circular Letter 2000-02 mandating fair investigations of low speed impact automobile accidents. Use to combat insurance company fraud.
You want action? You want results? Then join ACS if you are not already a member. Now. You can find a membership application at www.AZChiropractors.org.